NIHB Handbook - First Nations Health Council

Where to Submit an Appeal for Dental, Medical Suppliesand Equipment, Vision, Mental Health and MedicalTransportation BenefitsTo initiate an appeal, the individual should submit their documentation addressed to the NIHBRegional Manager, clearly marked "APPEALS-CONFIDENTIAL" and mail it to the Regional Office.If the individual does not agree with the Level 1 Appeal decision, the individual may chooseto have the appeal reviewed at the second level. The submission should be addressed to theNIHB Regional Director, and mailed to the Regional Office.If the individual does not agree with the Level 2 Appeal decision, the individual may chooseto have the appeal reviewed at the third and final level. The submission should be addressedto the NIHB Director General, and mailed to the NIHB Program, First Nations Inuit HealthBranch, Health Canada, Postal Locator 1919A, Tunney’s Pasture, Ottawa, Ontario K1A 0L3.Where to Submit an Appeal for Orthodontic BenefitsThe appeal must be submitted before the child reaches the age of 18. No appeals will beconsidered after the individual’s 18 th birthdayFor an appeal to an orthodontic benefit, the following information and diagnostic test resultsmust be provided and submitted by your Orthodontist or provider:1. Diagnostic Orthodontic Models -- soaped and trimmed (mounted or unmounted);2. Cephalometric – radiograph(s) and tracing;3. Photographs – 3 intra oral and 3 extra oral;4. Panoramic radiograph or full mouth survey;5. Treatment plan, estimated duration of active and retention phases of treatment and costssubmitted either on a NIHB Orthodontic Summary Sheet, CAO Standard OrthodonticInformation Form or letter on the Orthodontist’s letterhead;6. Completed NIHB Dent-29 Form; and7. Parent/Guardian signature (including Band name and number and/or date of birth).To initiate an appeal, the parent/guardian should submit their documentation addressed tothe NIHB Orthodontic Consultant, and mailed to the Orthodontic Review Centre, Non-InsuredHealth Benefits, First Nations Inuit Health Branch, Health Canada, Postal Locator 1919A,Tunney’s Pasture, Ottawa, Ontario K1A 0L3.If the parent/guardian does not agree with the Level 1 Appeal decision, the parent/guardianmay choose to have the appeal reviewed at the second level. The submission should beaddressed to the Director, Benefit Management, and mailed to the Orthodontic ReviewCentre Non-Insured Health Benefits, First Nations Inuit Health Branch, Health Canada, PostalLocator 1919A, Tunney’s Pasture, Ottawa, Ontario K1A 0L3.25